Primary eosinophilic gastrointestinal disorders and allergy: Clinical and therapeutic implications

Abstract

Primary eosinophilic gastrointestinal disorders (EGID) are increasingly prevalent, immune‐mediated, chronic conditions which primarily affect pediatric and young adult patients, leading to substantial disease burden, and poor quality of life. EGID may either involve single portions of the gastrointestinal tract (i.e., esophagus, stomach, small bowel, and colon) or a combination. Their strong association with allergic disorders has been recently recognized, and although their shared pathophysiological basis remains partly elusive, this feature greatly impacts the diagnostic and treatment work‐up. We herein critically discuss the current knowledge on the association of EGID and allergic disorders, including atopic dermatitis, allergic rhinitis, allergic asthma, and food or drug allergy. In particular, we reviewed the literature focusing on their epidemiology, pathophysiological basis and mechanisms, and diagnostic strategies. Finally, we discuss the currently ongoing clinical trials targeting EGID and allergic diseases, including, among others the monoclonal antibodies dupilumab, mepolizumab, benralizumab, and lirentelimab.

Abdominal Pain Due to Eosinophilic Gastroenteritis Diagnosed in 25-Year-Old and 27-Year-Old Sisters with a Family History of Asthma

“…The prevalence of atopy in patients with EG and gastroenteritis appears to be high, at 38.5% and 45.6%, respectively [6]. Although the etiology and pathogenesis of EGID remain unclear, EG or gastroenteritis are associated with asthma and other allergic conditions, such as allergic rhinitis, drug or food allergies; eczema; or other autoimmune conditions, such as HIV infection or systemic lupus erythematosus [7]; however, strong evidence for a comparison with eosinophilic esophagitis is lacking [6].…”

“…Although the etiology and pathogenesis of EGID remain unclear, EG or gastroenteritis are associated with asthma and other allergic conditions, such as allergic rhinitis, drug or food allergies; eczema; or other autoimmune conditions, such as HIV infection or systemic lupus erythematosus [7]; however, strong evidence for a comparison with eosinophilic esophagitis is lacking [6]. Despite this, self-reported rates of allergic rhinitis and asthma were still found to be associated, as high as 63% and 39%, respectively [6].…”

Eosinophilic Gastrointestinal Diseases in Inborn Errors of Immunity

“…Allergic comorbidities are prevalent in patients with EGIDs. However, several non-allergic diseases have also been associated with EoE, including autism spectrum disorders, coeliac disease, esophageal malformation, and inflammatory bowel disorders [ 16 , 17 , 18 ]. EoE is now considered a type 2-mediated disease, developing from a genetic predisposition and impaired esophageal barrier functioning [ 19 ].…”

High prevalence of sensitization to non-specific lipid transfer protein in adult patients with primary eosinophilic gastrointestinal disorders in Italy: a single center series

“…An increased awareness of these entities has allowed -at least for some of them- an earlier diagnosis. Besides, pathogenesis-driven therapies will probably be available shortly [ 1 , 2 ].…”

“…On these bases, in the present study we retrospectively evaluated all consecutive cases of adult-onset primary EGID referred to our allergy outpatient clinic in Northern Italy, from 2020 to 2021, for assessing the sensitization profile to food and other allergens. The diagnosis of primary EGID was made according to internationally-recognized criteria, including tissue eosinophil infiltration reaching the predefined cut-off level for each segment of the gastrointestinal tract, after the exclusion of secondary or systemic causes, such as drug reactions, helminthic infections, and hypereosinophilic syndrome [ 2 ].…”